Abdominal Wall Evisceration Coupled With Iliac Vascular Injury After Blunt Trauma.

Abdominal evisceration after blunt trauma is uncommon and rarely survivable when coupled with a concomitant iliac vascular injury. Blunt abdominal injury is rarely a cause of abdominal evisceration but may, on occasion, present in patients affected by a unique or high-energy traumatic injury. In these instances, major vascular injury is exceedingly rare but is associated with a high mortality rate. Damage to important vessels that may present more subtly, such as iliac arterial injury, can still be lethal and are important to evaluate in the trauma workup for blunt evisceration. We report the case of a 20-year-old woman who survived an abdominal wall and vascular injury in a motor vehicle accident. Management of this unusual association is discussed.

Evisceration of intestines with diaphragmatic laceration and gastric perforation secondary to trauma by rhinoceros attack and its management: a case report.

Injuries from animal attack are one of the major public health problems at present scenario globally. Proper documentation is required for the study of different types of injuries caused by animal attacks so that early intervention can be done during life-threatening conditions. Case Presentation: A 36-year-old male presented with an alleged history of attack by two rhinoceros sustaining injuries over the abdomen, chest, shoulder and thigh. Clinical Findings and Investigations: There was a lacerated abdomen with evisceration of the stomach, small intestine, transverse colon and omentum and a lacerated wound over the left lateral thigh and left buttock along with the right shoulder. Extended Focused Assessment with Sonography in Trauma ultrasound showed minimal free fluid in the pelvis. Blood profile revealed reduced haemoglobin and deranged prothrombin time/international normalized ratio. Interventions and Outcome: Patient underwent exploratory laparotomy twice with repair of diaphragmatic injury, excision of avulsed greater omentum in the first setting and repair of gastric perforation in the second setting with stable haemodynamic status. Conclusion: Abdominal evisceration injury by rhinoceros attack is life threatening though rare. Its management should consist of assessing for and controlling associated haemorrhage, assessing for bowel content leakage, covering the eviscerated abdominal contents and early reduction of viscera if there is no active bleeding.

Self-inflicted stab injury with abdominal evisceration: A case report.

INTRODUCTION AND IMPORTANCE: Self-inflicted abdominal stab injury with an intention of self-harm is uncommon. Moreover, self-inflicted injury leading to avulsion of the colon has rarely been reported in the literature. We report a case of a 42-years-female with schizoaffective disorder who presented with self-inflicted stab injury on the abdomen resulting in abdominal evisceration. PRESENTATION OF CASE: A 42-years-female with schizoaffective disorder (F25) for 10 years presented to the emergency department with multiple, self-inflicted injuries on the abdomen. A large free portion of the omentum and segment of the bowel were brought in a plastic carry bag. Examination revealed multiple transverse hesitation cuts in the epigastrium and a single deep penetrating transverse cut resulting in the evisceration of the omentum and colon. Intra-operatively, avulsion of a large portion of the greater omentum and missing segment of the mid transverse colon was observed. The patient underwent an immediate abdominal exploration and side-to-side colo-colic anastomosis along with diversion ileostomy. At three months following primary surgery, ileostomy closure was done. CONCLUSION: Patients with schizophrenia spectrum psychosis are at risk of self-harm and in our case a schizoaffective patient presented with self-inflicted injuries that required an emergency abdominal exploration and repair. This case highlights a multi-disciplinary approach for the management of these cases and mandates clinicians and caregivers to be more vigilant to restrict injuries in the future.

Intestinal Evisceration in Children From the Bite of the Domestic Pig, Sus scrofa domesticus: A Report of Two Cases.

Pig bite injuries are an infrequently described consequence of human-animal conflict. The domestic pig is thought to be a placid animal not given to unprovoked aggression. We report 2 separate cases of children managed at our institution who sustained abdominal injuries after attack by domestic pigs in rural Zimbabwe. Both incidents occurred at home in remote rural areas with long prehospital transport times. Initial resuscitative interventions were performed in both cases in the prehospital setting and at poorly resourced peripheral hospitals before referral. Prophylactic antibiotics were also given in both cases. Laparotomy was performed for both patients. Reduction of eviscerated bowel, exploratory laparotomy, and peritoneal lavage were performed with closure of the abdominal wounds. No surgical site infections were encountered, and patients were subsequently discharged after an uneventful convalescence. Prehospital care is the crucial phase of management of these injuries, which frequently take place in remote, rural settings and usually have a long time to definitive intervention. Expeditious laparotomy and exploration are indicated, as well as meticulous attention to techniques to avert infectious complications. Despite the generally placid temperament of the domestic pig, their bite can result in grave injuries, including abdominal evisceration necessitating prompt referral and emergency laparotomy.

Evisceración abdominal postraumática en un niño / Post-traumatic abdominal evisceration in a child

Introducción: Se considera un paciente politraumatizado aquel que presenta dos o más lesiones, de las que al menos una puede comprometer su vida o vaya a originar secuelas invalidantes. Una conducta inicial adecuada puede reducir la mortalidad de pacientes como el que se presenta, pues la atención inicial debe ser ordenada y sistemática; siempre se deben identificar y tratar con prioridad, las lesiones que comprometen la vida del paciente. Objetivo: Presentar un caso, que por su interés y singularidad en el mecanismo de acción, expone la secuencia de actuación que se llevó a cabo por cirujanos generales, fuera de un servicio de cirugía pediátrica. Caso clínico: Se reporta el caso de un paciente masculino de 6 años de edad, que acude al cuerpo de guardia politraumatizado y presenta una avulsión músculo cutánea abdominal con evisceración intestinal, al sufrir caída en movimiento con traumatismo abdominal penetrante con biela de pedal de una bicicleta. A pesar de no contar en la institución de atención, con servicio de cirugía pediátrica, se impuso la cirugía de emergencia por las condiciones del paciente. Conclusiones: Luego de laparotomía inicial con reconstrucción de la pared abdominal y cierre primario con puntos de seguridad, el paciente evolucionó de forma estable. Fue remitido para un servicio de terapia intensiva pediátrica, donde y evolucionó sin complicaciones, hasta su egreso(AU)

Introduction: A polytraumatized patient is considered to be one who presents two or more injuries, of which at least one may compromise his life or cause disabling sequelae. An adequate initial behavior can reduce the mortality of patients such as the one that occurs, because the initial attention must be orderly and systematic, the lesions that compromise the patient's life must always be identified and treated with priority. Objective: To present a case, which due to its interest and uniqueness in the mechanism of action, exposes the sequence of action that was carried out by general surgeons, outside of a pediatric surgery service. Clinical case: We report the case of a 6-year-old male patient who came to emergency, polytraumatized and presenting an abdominal skin muscle avulsion with intestinal evisceration, he suffered a fall during movement with penetrating abdominal trauma with a bike pedal crank. Despite not having a pediatric surgery service in the attending institution, emergency surgery was imposed due to the patient's conditions. Conclusions: After the initial laparotomy with reconstruction of the abdominal wall and primary closure with security points, the patients evolves in a stable way, he was referred to a pediatric intensive care service, where he evolved without complications until discharge(AU)